Aging In Place In a CCRC

A Key Feature of CCRC Living:

Regardless of whether the consumer is in their 60's or 80's, moving into a continuing care retirement community (CCRC) is never an easy decision. The impact of the current housing crisis on the decision-making process is lengthening the sales cycle. Moving a consumer from the status of "prospective resident" to "resident" has never been longer and the route more arduous. CCRC marketing materials (here and here) relating to eliminating the burden of the cost and worries associated with home ownership are of lesser importance than the central value proposition offered by this housing model: the consumer will be able to age in place. Research shows that the peace of mind associated with knowing that debilitation in physical or cognitive functioning will not trigger a relocation from the community, but rather will "merely" necessitate a move to a different care center on property, is a critical-to-success feature all CCRC's! Got it?

What Can Go Wrong?

The past week, Harbor's Edge retirement community in Norfolk, Virginia received bad press (here) due to its decision to restrict access to its fine dining room to only those residents who live in the independent living portion of the campus, forcing those who have higher-care needs to dine separately. As reported, this rule creates a unique hardship for those residents whose significant other lives in the ALF or SNF portion of the campus: they must now dine apart. Additionally, since the rule makes no exception based-upon cognitive functioning, some of those who are now prohibited from the fine dining room must dine with individuals with whom they can share in no meaningful interaction.

The challenge for those who own and operate a CCRC, is to remain true to the key feature of this housing model (i.e. being able to age-in-place) with the "perceived" marketing necessity of appearing "fresh, youthful and vibrant." Hence, the banishment of those who require walkers, wheel chairs and attendants who can provide any level of assistance with eating from the independent living portion of the community. In my experience, although older adults question sale staff about this issue prior to move-in, the conversation is very abstract and few individuals consider the subtle effects of normal aging which can diminish capacity slowly over time, rather then a sudden permanent and significant change in ADL functioning following an acute health event. Additionally, there is no standard in the CCRC industry on how to address this issue. Regulation of the industry is spotty and accreditation with the industry's accrediting organization (CCAC) is voluntary.  Although some communities proudly market the socialization possibilities which occur from mixing clients who a varying level of care needs (here), that is the exception. Typically, each provider has a published policy which may change based upon census/market demands (fewer admissions to independent living may mean a more relaxed policy regarding allowing those with greater level of care needs to remain in independent housing or assisted living).

Remedies:

The Fair Housing Act (FHA), which protects peoples choice regarding where they want to live, and the Americans with Disabilities Act (ADA) both impact questions of accessibility to, and within a CCRC community. In the case of Harbor's Edge, its current policy is being legally challenged by those affected. Consistent and transparent application of policies regarding aging in place is paramount. CCAC accreditation is a good indicator that best practices are applied when addressing a community member's changing health and custodial care needs.

What are your thoughts?

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    Bruce Lederman

    Bruce Lederman has over 25 years experience in the senior care field as a direct care provider and thought leader. Bruce was CEO and president of his own firm that operated skilled nursing facilities in Illinois. He is a former nursing home administrator and has consulted to numerous elder care providers on planning for strategic growth as well as process improvement. Recently he served as board chair of CJE SeniorLife, a leading non-profit elder care provider in the Chicago area. Bruce is currently employed as chief strategy officer for a multi-facility skilled nursing facility company.

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